Role of Alcohol in Forensic Deaths --
Westchester County, New York, 1989

In the United States, 58% of all adults consume alcohol, and
death rates for most injuries and some diseases increase directly
in relation to levels of consumption (1-3). Forensic deaths (i.e.,
deaths certified under the medical examiner system) include a
substantial proportion of cases for which alcohol use may have
contributed to the death; in many cases, this system provides
detailed medical information on causes of death because of
autopsies and blood alcohol level testing. To further characterize
alcohol-related deaths in Westchester County (4,5), the New York
Medical College (NYMC) and the Westchester County Department of
Laboratories and Research (WCDLR) estimated the total
alcohol-related mortality (ARM) and years of potential life lost
before age 65 (YPLL) for all deaths certified by the medical
examiner for Westchester County, New York, during 1989. This report
summarizes the findings and addresses public health applications
for estimating ARM employing this method.

The NYMC and WCDLR used Alcohol-Related Disease Impact (ARDI)
software to estimate the overall mortality from both acute injuries
and chronic diseases associated with alcohol use or misuse (6).
ARDI is based on an established set of diagnoses causally related
to alcohol and estimates of alcohol-attributable fractions (AAFs)
for each diagnosis (6).

Westchester County (1990 U.S. census population: 874,866),
north of New York City, is both urban and suburban and is served by
a single medical examiner's office. Of the 7974 persons who died
within Westchester County during 1989, 1097 (14%) deaths were
reviewed by the Westchester County medical examiner, and 645 (59%)
autopsies were performed. The NYMC and WCDLR reviewed each record
to obtain data on age, sex, race, place of residence, date and
place of injury and death, manner and cause of death, other
involved conditions, blood alcohol concentration (BAC), and the
presence of other toxicologic substances. To determine estimates of
ARM and YPLL by age, sex, and specific diseases, alcohol-related
deaths were combined with estimated AAFs.

The Westchester County medical examiner's office obtains a BAC
on nearly all persons autopsied; however, autopsies were more
likely to be performed when the diagnoses were alcohol related (398
(86%) versus 247 (39%)). Of the 1097 persons, 465 (42%) were
determined to have had alcohol-related diagnoses (Table 1). BACs
had been determined for 359 (77%) persons with an alcohol-related
diagnosis and 229 (36%) persons without an alcohol-related
diagnosis.

Persons with an alcohol-related diagnosis were younger and
were more likely to be male, race other than white, and noncounty
residents, and to have died outside of a hospital or health
facility. BAC levels were significantly higher (p=0.001) for the
alcohol-related death group.

Of the 1097 deaths reviewed by the medical examiner's office,
165 (15%) were estimated to be attributable to alcohol.
Unintentional and intentional injuries, digestive-system diseases,
and excess blood alcohol (usually in association with other
diseases or drugs) accounted for 95% of all alcohol-attributable
deaths. An estimated 119 (17%) deaths among the 699 males and 46
(12%) among the 398 females in this population were attributable to
alcohol. The mean YPLL per alcohol-related death was 18.2 years.

Editorial Note

Editorial Note: Previous reports based on the use of ARDI have
measured the impact of alcohol on mortality in the U.S. and in
Wisconsin (7,8). During 1987, 6.3% of deaths among males and 3.4%
among females were attributable to alcohol (7). However, because a
higher proportion of deaths reviewed by the medical examiner's
office in Westchester County were alcohol-related injury deaths,
the alcohol-attributable mortality described in this report is
higher.

Despite the limitations of studies based on highly selected
forensic deaths, the findings described in this report are similar
to published total county-specific alcohol-related death rates that
are based on diagnostic groups and similar AAFs (9). From 1979
through 1985, in Westchester County, an estimated 220 (range:
161-280) alcohol-attributable deaths occurred annually. The
estimate of 165 alcohol-related deaths in forensic cases for 1989
in this report suggests that approximately 75% of all
alcohol-attributable deaths occurring within the county were
captured using this method. Therefore, this method can provide a
measure of the burden of alcohol use and misuse and assist state
and local public health professionals and policy makers in better
characterizing the public health impact of alcohol use and misuse.
Westchester County health-care providers, social agencies, and
planning organizations can use these data to estimate the impact of
alcohol use locally and to target specific strategies toward this
problem.

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